Healthcare Provider Details

I. General information

NPI: 1306848080
Provider Name (Legal Business Name): OBUNIKE O EDOKWE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 N 13TH ST
NEWARK NJ
07107-1317
US

IV. Provider business mailing address

66 W GILBERT ST SUITE 100
TINTON FALLS NJ
07701-4918
US

V. Phone/Fax

Practice location:
  • Phone: 973-268-1400
  • Fax:
Mailing address:
  • Phone: 721-212-0060
  • Fax: 732-212-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA05586100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: